Baseline and 7-Year Longitudinal Trajectories of Systolic Blood Pressure and All-Cause Mortality in the Elderly: A Large Prospective Cohort Study in China, 2017-2023.
老年人收缩压和全因死亡率的基线和 7 年纵向轨迹：2017-2023 年中国大型前瞻性队列研究 。

Zhuo Wang^1,*, Yujin He^1,*, Tianyong Wu^2,*, Zifang Zhou³, Zhi Lei², Rujun Liao¹, Fangyi Yu⁴, Pengyuan Yang⁴, Xiaoyan Wang², Ling Liu², Longling Yang², Qing Yang², Xuefeng Tang¹, Xianping Wu¹, Bo Zhong^1,#, Hang Chen^2,#, Peng Yin³
王卓 ^1，*，何玉金 ^1，*，吴天勇 ^2*， 周子芳 ³， 智磊 ²， 廖汝军 ¹，于芳毅 ⁴，杨鹏远 ⁴，王晓燕 ²，刘玲 <sup id=47>2，杨龙玲 ²，杨庆 ²， 唐雪峰 ¹， 吴先平 ¹，钟波 ^1，#，陈航 ^2#，尹鹏 ³
Affiliations:
附属机构：
1 Department of Chronic and Non-communicable Disease Control and Prevention,
1 慢性和非传染性疾病控制和预防司，
Sichuan Center of Disease Control and Prevention, Chengdu, China.
四川省疾病预防控制中心。
2 Department of Chronic and Non-communicable Disease Control and Prevention,
2 慢性和非传染性疾病控制和预防司，
Luzhou Center of Disease Control and Prevention, Luzhou , China.
泸州市疾病预防控制中心 。
3 National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
3 中国疾病预防控制中心国家慢性非传染性疾病预防控制中心，中国北京。

4 School of Public Health, North Sichuan Medical College, Nanchong, China.
4 四川省南充市川北医学院公共卫生学院 。

^# Correspondence to:
^# 通信对象：
Bo Zhong, PhD, 6 Zhongxue Road, Wuhou District, Chengdu City, Sichuan Province, China. Tel: +86-28-85587325; Email: zhongbo1969@163.com
中国四川省成都市武侯区中学路 6 号 ，博士。电话：+86-28-85587325;邮箱：zhongbo1969@www.example.com163.com

Hang Chen, B.S, 88 Huiyuan Road, Dongsheng District, Luzhou City, Sichuan Province, China. Tel: +86-0830-2584041; Email: 331999258@qq.com
陈航 ， 四川省泸州市东胜区汇源路 88 号 B.S。电话：+86-0830-2584041;邮箱：331999258@qq.com

* Zhuo Wang, Yujin He and Tianyong Wu contributed equally to this work.
* 王卓、何玉津和吴天勇对这项工作做出了同等贡献。

OBJECTIVES: To comprehensively evaluate the association between systolic blood pressure (SBP)and death risk in people aged 65 years and over in Luzhou, China, and suggest the optimal range of SBP for the older adults.
目的：综合评价泸州市 65 岁及以上老年人收缩压（SBP）与死亡风险的关系，并提出老年人 SBP 的最佳范围。

DESIGN: A prospective cohort study.
设计： 前瞻性队列研究。

SETTING: A population-based study of elderly adults in Luzhou, China.
单位：一项以中国泸州市老年人为研究对象的人群研究。

PARTICIPANTS: 390,100 elderly people aged 65 and above were followed up for a total of 1,994,050 person-years with 48,013 deaths were included in this analysis.
对象：对 390,100 名 65 岁及以上老年人进行了随访，共 1,994,050 人年，其中 48013 人死亡。

MEASURES: Cox proportional hazards regression model estimated the all-cause mortality risk associated with SBP categories. The Restricted Cubic Spline (RCS) Cox regression model estimated the relationship between baseline SBP, 7-year mean SBP, and mortality rate on a continuous scale.
测量： 考克斯比例风险回归模型估计与 SBP 类别相关的全因死亡风险。限制性三次样条（RCS）考克斯回归模型在连续量表上估计基线 SBP、7 年平均 SBP 和死亡率之间的关系。

RESULTS: Among the 390,100 participants included in the preliminary analysis, the mean ± standard deviation age at baseline was 71.34 ± 5.72 years old. For baseline SBP, lower all-cause mortality rates (HR<1) were observed at Grade 2 (100~119 mmHg) and Grade 3 (120~139 mmHg). For the average SBP over 7 years, lower all-cause mortality rates were observed at Grade 3 (120~139 mmHg) and Grade 4 (140~159 mmHg). The 7-year SBP trajectory at Class 2 level, where blood pressure gradually increases from normal-high values with age, had the lowest all-cause mortality rate; the 7-year SBP trajectory at Class 1 level, where blood pressure gradually increases from ideal values with age, had the lowest cardiovascular mortality rate; the 7-year SBP trajectory at Class 3 level, where blood pressure gradually increases from mild hypertension with age, had the lowest mortality rates from cancer and other diseases excluding cardiovascular and cancer.
结果： 在初步分析的 390，100 名参与者中，基线年龄的平均值±标准差为 71.34±5.72 岁。 对于基线 SBP，在 2 级（100~119 mmHg）和 3 级（120~139 mmHg）时观察到较低的全因死亡率（HR<1）。对于 7 年的平均 SBP，3 级（120~139 mmHg）和 4 级（140~159 mmHg）的全因死亡率较低。 2 级水平的 7 年 SBP 轨迹 ，即血压随年龄从正常值逐渐升高至高值，具有最低的全因死亡率; 1 级水平的 7 年 SBP 轨迹 ，即血压随年龄从理想值逐渐升高，具有最低的心血管死亡率; 3 级水平的 7 年 SBP 轨迹 ，即血压随年龄从轻度高血压逐渐升高，具有最低的癌症和除心血管和癌症外的其他疾病死亡率 。

CONCLUSION: As age increases, the systolic blood pressure of elderly people may need to gradually rise from normal blood pressure to stage 1 hypertension (no more than 160 mmHg), even a bit higher to achieve a lower mortality rate.
结论： 随着年龄的增长，老年人的收缩压可能需要从正常血压逐渐升高到 1 级高血压（不超过 160 mmHg），甚至稍高一点才能达到较低的死亡率 。

Key words: Systolic Blood pressure, olderly , mortality, Chinese, Prospective Cohort.
关键词： 收缩期血压 ， 老年人 ， 死亡率，中国人，前瞻性队列。

Introduction
介绍

As increasing age, arteriosclerosis causes an increase in systolic blood pressure (SBP), which is an important predictor of cardiovascular disease (CVD) events and all-cause mortality and better indicator of CVD risk in olderly¹. Therefore, achieving optimal blood pressure control is an important healthcare measure and challenge. However, the target blood pressure value, especially for the elderly, is still controversial. With the intensification of global aging, the burden of diseases related to hypertension levels is increasing, and more evidence is needed to support the appropriate levels of SBP in the elderly population².
随着年龄的增长，动脉硬化导致收缩压 （SBP） 升高，这是心血管疾病（CVD）事件和全因死亡率的重要预测因素 ，也是老年人 CVD 风险的更好指标 ¹。 因此，实现最佳血压控制是一项重要的医疗保健措施和挑战。然而，目标血压值， 尤其是老年人的血压值，仍然存在争议。 随着全球老龄化的加剧，与高血压水平相关的疾病负担也在增加，需要更多的证据来支持老年人群 SBP 的适当水平 ²。

Some clinical reports indicate that in order to reduce the incidence of cardiovascular events, older patients with hypertension need to control systolic blood pressure to 110 to 130 mmHg or less^3,4. However, there are also reports that strengthened blood pressure control leads to a higher incidence of adverse events, such as hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, in older adults^5,6. In addition, it has been reported that the long-term trajectory of blood pressure in the elderly is also closely related to their underlying health. As long as systolic blood pressure is not chronically higher than 180mmHg, it will not increase cognitive ability, dementia risk, and all-cause mortality in the elderly⁷. Due to the coexistence of multiple diseases in the elderly, strict control of SBP in the elderly may not reduce the risk of fatal and non-fatal major cardiovascular events⁸.In addition, appropriate blood pressure is necessary to ensure the blood nutritional needs of all organs in the body. Each organ may have different needs for blood pressure levels, so appropriate blood pressure levels should not be established simply based on individual organ protection (such as cerebrovascular protection).⁹ Currently, there is still controversy regarding the level of SBP and its development trajectory in the elderly without significantly increasing the risk of serious adverse events^10-12. Therefore, more evidence is needed to comprehensively reflect blood pressure and health outcomes in the elderly.
一些临床报告表明，为了降低心血管事件的发生率，老年高血压患者需要将收缩压控制在 110 至 130 mmHg 或更低 ^3，4。 然而，也有报告称，在老年人中，加强血压控制会导致不良事件的发生率更高，如低血压、晕厥、电解质异常和急性肾损伤或肾衰竭 ^5，6。 此外，有报道指出，老年人血压的长期变化轨迹也与其基础健康密切相关。 只要收缩压不长期高于 180 mmHg，就不会增加老年人的认知能力、痴呆风险和全因死亡率 ⁷。 由于老年人多种疾病并存，严格控制老年人的 SBP 可能不会降低致命性和非致命性重大心血管事件的风险 ⁸。 此外，适当的血压是必要的，以确保血液营养需要的所有器官的身体。 每个器官可能对血压水平有不同的需求，因此不应简单地根据个别器官保护（如脑血管保护）来建立适当的血压水平 。⁹ 目前，关于老年人的 SBP 水平及其发展轨迹仍存在争议，但不会显着增加严重不良事件的风险 ^10-12。因此，需要更多的证据来全面反映老年人的血压和健康结果 。

Therefore, we aim to conduct a cohort study using a 7-year natural population physical examination data from Luzhou, China, to test the correlation between baseline SBP and longitudinal SBP trajectories and overall mortality risk.
因此，我们的目标是使用来自中国泸州的 7 年自然人群体检数据进行队列研究 ，以检验基线 SBP 和纵向 SBP 轨迹与总体死亡风险之间的相关性。

Materials and methods
材料和方法

Data source and study population
数据来源和研究人群

The Luzhou Elderly Cohort is a longitudinal cohort study conducted in Luzhou city with a population of approximately 5 million in western China, covering all elderly populations. From 2017 to 2023, elderly people underwent seven consecutive years of physical examinations. The collected data items are in accordance with the requirements of basic public health services carried out in China¹³. Face to face interviews were carried out according to a standardized protocol to collect demographics and lifestyle information for all participants aged 65 years and above. Physical examinations were administered and blood samples were taken after 24 hour fasting by trained professionals.
泸州老年队列研究是在中国西部泸州市进行的一项纵向队列研究 ，人口约为 500 万，涵盖所有老年人群 。从 2017 年到 2023 年 ，老年人连续七年进行体检。所收集的数据项目均符合我国开展基本公共卫生服务的要求 。 根据标准化协议进行面对面访谈，以收集所有 65 岁及以上参与者的人口学和生活方式信息。 由经过培训的专业人员进行体格检查 ，并在禁食 24 小时后采集血样 。

In this study, 497,511 participants from 2017 to 2018 were initially included. We excluded participants who had less than 3 examinations (N=390,453), and whose systolic blood pressure on the left side was less than 60mmHg (N=4); whose date of death was earlier than the date of the last physical examination (N=349). Finally, 390,100 elderly people aged 65 years or older participated in the final analysis (Fig. 1).
在这项研究中，最初纳入了 2017 年至 2018 年的 497，511 名参与者。我们排除了检查次数少于 3 次的受试者（N= 390，453），左侧收缩压低于 60 mmHg 的受试者（N=4）;死亡日期早于末次体格检查日期的受试者（N=349）。最后，390，100 名 65 岁以上的老年人参加了最终分析（图 1）。

This study was approved by the Luzhou Center for Disease Control and Prevention Ethics Review Committee (LZCDC/LS-2023001), and all participants have informed consent.
本研究经泸州市疾病预防控制中心伦理审查委员会（LZCDC/LS-2023001）批准，所有参与者均知情同意。

SBP measurement and covariates
SBP 测量值和协变量

Blood pressure were measured twice in left arm using mercury sphygmomanometer by a trained doctor according to standard protocols. Participants sit in a quiet and comfortable temperature room, after resting at least 5 minutes. If the difference between the two measurements was greater than 10mmHg, a third measurement will be conducted and the average value was used in further analysis.
由受过训练的医生根据标准方案使用汞血压计在左臂测量血压两次。参与者坐在安静舒适的温度室中，休息至少 5 分钟。如果两次测量值之间的差异大于 10 mmHg，则将进行第三次测量，并将平均值用于进一步分析。

Information on age, gender, marital status (unmarried, married, widowed, divorced), educational level (illiterate, primary or middle or high school, college or above, unknown), tobacco smoking (current, former, never), alcohol drinking (everyday, often, occasionally, never) and physical activity (less than once/week, more than once/week, everyday) was obtained through questionnaires. Height, weight, waist circumference, total cholesterol, fasting blood glucose were also measured or tested by professional doctors.
通过问卷调查获得年龄、性别、 婚姻状况（未婚、已婚、丧偶、离婚）、文化程度（文盲、 小学或初中或高中、大学或以上、不详）、吸烟（目前、 以前、从不）、饮酒（每天、经常、偶尔、从不）和体力活动（每周少于一次、每周多于一次、每天） 等信息。身高、体重、 腰围 、总胆固醇、空腹血糖由专业医生测量或检测。

Mortality and follow-up
死亡率和随访

The vital status of participants were obtained by linking with the China Population Death Information Registration System. It is a well-established system and collects all deaths occurred in mainland China including hospital deaths and outside of hospital deaths. Strict quality control measures were in place to ensure the completeness and accuracy of the reported death cases¹⁴. The unique national IDs of all the participants were linked with the China Population Death Information Registration System and the date and cause of death of the deceased were obtained. The end date of follow-up is the date of death or December 31, 2023, whichever comes first. Participants who died from any cause were included in the outcome analysis.
通过与中国人口死亡信息登记系统的连接，获得参与者的生命状态。 这是一个完善的系统，收集了中国大陆发生的所有死亡，包括医院死亡和医院外死亡。我们已采取严格的质量控制措施，以确保报告的死亡个案的完整性和准确性 ¹⁴。所有参与者的唯一身份证与中国人口死亡信息登记系统相关联 ，并获得死者的死亡日期和死因 。随访结束日期为死亡日期或 2023 年 12 月 31 日，以先到者为准 。 任何原因死亡的参与者都被纳入结果分析。

Statistical analysis
统计分析

The study population was divided into six groups according to observed baseline SBP (<100, 100–119, 120–139, 140–159, 160–179, and ≥180mmHg). According to the baseline SBP classification and the 7-year average SBP classification, the longitudinal SBP trajectory is divided into three categories: blood pressure gradually increases from ideal values with age; blood pressure gradually increases from normal-high values with age; blood pressure gradually increases from mild hypertension with age (Fig. S1). According to the data type, participants are classified according to baseline SBP and 7-year SBP trajectories, and their characteristics are represented as the mean ± SD of continuous variables and n (%) of categorical variables. The mortality rate was calculated by dividing the number of deaths by the total number of follow-up duration.
根据观察到的基线 SBP（% 3 C 100、100-119、120-139、140-159、160-179 和 ≥180 mmHg）将研究人群分为 6 组。 根据基线 SBP 分类和 7 年平均 SBP 分类，纵向 SBP 轨迹分为三类： 血压随年龄从理想值逐渐升高 ; 血压随年龄从正常-高值逐渐升高 ; 血压随年龄从轻度高血压逐渐升高（ 图 1）。 S1）。根据数据类型，根据基线 SBP 和 7 年 SBP 轨迹对受试者进行分类 ，其特征表示为连续变量的均值± SD 和分类变量的 n（%）。死亡率的计算方法为死亡人数除以随访时间总数。

Kaplan Meier curve and logarithmic rank test were used to compare the differences in mortality rates among elderly individuals grouped according to the 7-year SBP trajectory. Cox proportional hazards regression model was used to estimate the risk ratios (HRs) and 95% confidence intervals (CIs) of all-cause mortality in the baseline SBP groups and 7-year SBP trajectory groups, as well as different baseline and trajectory combinations, using survival days as the time scale, and gradually adjust for potential confounding factors in the multivariate Cox model: sex, age, marital status, educational level, tobacco smoking, alcohol drinking, physical activity, 7-year average waist circumference, 7-year average fasting blood glucose, 7-year average total cholesterol, 7-year average body mass index¹⁵. We used restricted cubic spline (RCS) Cox regression model to examine the association between baseline SBP, 7-year mean SBP and mortality on a continuous scale, with or without age groups¹⁶.
采用 Kaplan-Meier 曲线和对数秩检验比较按 7 年 SBP 轨迹分组的老年人死亡率的差异。 使用考克斯比例风险回归模型估计基线 SBP 组和 7 年 SBP 轨迹组以及不同基线和轨迹组合的全因死亡率的风险比（HR）和 95%置信区间（CI）， 以生存天数为时间尺度，并逐步调整多变量考克斯模型中的潜在混杂因素：性别、年龄、婚姻状况、教育水平、吸烟、饮酒、体力活动、7 年平均腰围、7 年平均空腹血糖、7 年平均总胆固醇 、7 年平均 B 体质量指数 ¹⁵。 我们使用限制性三次样条（RCS）考克斯回归模型，在连续量表上检查基线 SBP、7 年平均 SBP 和死亡率之间的关系，包括或不包括年龄组 ¹⁶。

All statistical analyses were performed using R software version 4.3.2 (2023-10-23). All statistical tests were two-sided and P < 0.05 was considered statistically significant.
所有统计分析均使用 R 软件版本 4.3.2（2023-10-23）进行。所有统计学检验均为双侧检验，P < 0.05 视为具有统计学显著性。

Results
结果

Baseline characteristics and follow up
基线特征和随访

Characteristics of participants based on baseline SBP and 7-year SBP trajectories were shown in Table 1. Among the 390,100 participants included in the primary analysis, the mean ± SD age at baseline was 71.34 ± 5.72 years, 46.7% were men, 63.04% were married, 52.71% had primary or middle or High school education, 72.18% were never smoked, 79.34% were never alcohol drinking, and 84.1% were no exercise. The mean ± SD of waist circumference (WC), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) at baseline were 80.30 ±9.17 cm, 5.77 ±1.90mmol/l, 5.29 ± 23.03mmol/l and 23.29 ± 44.61kg/m² , respectively.
基于基线 SBP 和 7 年 SBP 轨迹的受试者特征见表 1。在纳入主要分析的 390，100 名参与者中，基线年龄的平均值± SD 为 71.34± 5。72 岁，46 岁 。7% 是男性，63 岁。04% 已婚，52。71% 有小学或初中或高中教育，72。18% 的人从不吸烟，79。34% 的人从不喝酒，84。1% 的人没有锻炼 。 基线时腰围（WC）、空腹血糖（FBG）、 总胆固醇（TC）和体重指数 （BMI）的平均值± SD 分别为 80.30±9.17cm、5.77±1.90mmol/l、5.29±23.03mmol/l 和 23.29±44.61kg/m²。

Participants with baseline SBP of<100mmHg (Grade 1), 100-119mmHg (Grade 2), 120-139mHg (Grade 3), 140-159mHg (Grade 4), 160-179mHg (Grade 5), and ≥ 180mmHg (Grade 6) accounted for 1.65% (n=6448), 16.87% (n=65804), 47.57% (n=185552), 21.79% (n=85022), 9.93% (n=38731), and 2.19% (n=8543), respectively. During the whole follow-up period, the systolic blood pressure of 35.82% (n=139,821), 48.75% (n=190,193), and 15.4% (n=60,086) of the participants gradually increased with age from ideal (Class 1), normal-high(Class 2), and mild hypertension (Class 3), respectively (Fig. S1, Fig. S2).
基线 SBP <100 mmHg（1 级）、100- 119 mmHg（2 级）、120- 139 mmHg（3 级）、140- 159 mmHg（4 级）、160- 179 mmHg（5 级） 和 ≥180 mmHg（6 级）的患者占 1. 65%（n=6448），16. 87%（n=65804），47. 57%（n=185552），21. 79%（n=85022），9. 93%（n=38731），和 2. 19%（n=8543）。 在整个随访期间，分别有 35.82%（n= 139，821）、48.75%（n= 190，193）和 15.4%（n= 60，086）的受试者收缩压随年龄从理想 （1 级）、正常 - 高 （2 级） 和轻度高血压 （3 级） 逐渐升高 （图 S1、 图 S2）。

A total of 1,994,050.42 person-years of follow-up was followed for seven years, and 48,013 deaths were identified, including 19,302 deaths from cardiovascular disease, 10,095 deaths from cancer, and 18,616 deaths from diseases other than cardiovascular and cancer. The all-cause mortality rate was 72.08 per 10,000 person-years, the cardiovascular mortality rate was 30.39 per 10,000 person-years, the cancer mortality rate was 14.74 per 10,000 person-years, and the mortality rate of other diseases except cardiovascular and cancer was 26.95 per 10,000 person-years (Table 2, Table S1, Table S2, Table S3).
共随访了 1，994，050.42 人-年，随访时间为 7 年，确定了 48，013 例死亡，其中 19，302 例死于心血管疾病，10，095 例死于癌症，18，616 例死于心血管和癌症以外的疾病。全因死亡率为 72.08/万人年，心血管死亡率为 30.39/万人年，癌症死亡率为 14.74/万人年，除心血管和癌症外的其他疾病死亡率为 26.95/万人年（表 2、表 S1、表 S2、表 S3）。

Relationship between continuous baseline SBP, 7-year mean SBP and all-cause mortality
连续基线 SBP、7 年平均 SBP 与全因死亡率的关系

The RCS regression model showed that there was a non-linear correlation (P<0.001) between baseline SBP, 7-year mean SBP, and all-cause mortality. For baseline SBP, the mortality risk was low with SBP values below 132 mmHg (HR<1) (Fig. 2A). For the 7-year average SBP, the mortality risk was low when the SBP value was between 136-144mmHg (HR<1) (Fig. 2B). After adjusting by marital status, education level, smoking, alcohol drinking, physical activity,7-year WC, 7-year TC, 7-year FBG, 7-year BMI, the mortality rate was lower when the baseline SBP was between 107-132mmHg, and lower when the 7-year average SBP was between 137-146mmHg (Fig. S3).
RCS 回归模型显示，基线 SBP、7 年平均 SBP 和全因死亡率之间存在非线性相关（P<0.001）。对于基线收缩压，收缩压值低于132 mmHg（HR<1）时死亡风险较低（图2A）。对于7年平均SBP，当SBP值在136- 144 mmHg（HR<1）之间时，死亡风险低（图2B）。经婚姻状况、受教育程度、吸烟、饮酒、体力活动、7年WC、7年TC、7年FBG、7年BMI调整后，基线SBP在107- 132 mmHg之间时死亡率较低，7年平均SBP在137- 146 mmHg之间时死亡率较低（图S3）。

Figure 3 showed the association between baseline and 7-year mean SBP and mortality in elderly aged 65-79, 70-74, 75-79, and 80 years and above. The baseline SBP of the age groups aged 65-79, 70-74, 75-79, and 80 years and above had a lower risk of mortality between 102-132, 116-132, 115-132, and 132-159mmHg, respectively (Fig. 3A). For the 7-year mean SBP, the risk of mortality were lower when the SBP values were between 137-141, 137-148, 137-151, and 137-158mmHg, respectively (Fig. 3B).
图 3 显示了 65-79 岁、70-74 岁、75-79 岁和 80 岁及以上老年人基线和 7 年平均 SBP 与死亡率之间的相关性。年龄为 65-79、70-74、75-79 和 80 岁及以上的年龄组的基线 SBP 分别在 102-132、116-132、115-132 和 132- 159 mmHg 之间具有较低的死亡风险 （图 3A）。 对于 7 年平均 SBP， 当 SBP 值分别在 137- 141、137- 148、137- 151 和 137- 158mmHg 之间时，死亡风险较低（图 3B）。

Associations between baseline SBP, 7-year SBP trajectories and all-cause mortality
基线 SBP、7 年 SBP 轨迹和全因死亡率之间的关系

Table 2 showed that using baseline SBP <100 mmHg as a reference, regardless of single or multiple factors, the Cox proportional hazards regression model showed an increased mortality risk for SBP <100mmHg or >160mmHg. Taking the 7-year SBP trajectory Class 1 as a reference, blood pressure gradually increases from normal-high values with age (Class 2) had the lowest risk of mortality. Model 4 showed that after adjusting for age, gender, marital status, education level, smoking, alcohol consumption, physical activity, 7-year WC, 7-year TC, 7-year FBG, 7-year BMI and 7-year SBP trajectory, the mortality risk for SBP was lower at Grade2 100~119mmHg (HR 0.91, 95% CI 0.84 - 0.98); after adjusting for baseline SBP, the Class 2, Blood pressure gradually increases from normal-high values with age, had a lower mortality risk (HR 0.9, 95% CI 0.88-0.92).
表 2 显示，以基线 SBP <100 mmHg 为参考，无论单因素还是多因素，考克斯比例风险回归模型显示 SBP 160 mmHg 死亡风险增加 <100mmHg or >。以 7 年 SBP 轨迹 1 级为参考，血压从正常值逐渐升高，随着年龄的增长（2 级）死亡风险最低。模型 4 显示，在调整年龄、性别、婚姻状况、受教育程度、吸烟、饮酒、体力活动、7 年 WC、7 年 TC、7 年 FBG、7 年 BMI 和 7 年 SBP 轨迹后，SBP 2 级 100~ 119 mmHg 的死亡风险较低（HR 0.91，95% CI 0.84 - 0.98）;调整基线 SBP 后，2 级血压随着年龄从正常-高值逐渐升高，死亡风险较低（HR 0.9，95% CI 0.88-0.92）。

Table 3 showed that using Grade 1 baseline SBP and Class 1 7-year SBP trajectory as a reference, regardless of individual or multiple factors, the mortality risk was reduced in Grade 2 baseline SBP and Class 1 7-year SBP trajectory, Grade 2 baseline SBP and Class 2 7-year SBP trajectory, Grade 3 baseline SBP and Class 2 7-year SBP trajectory, and Grade 3 baseline SBP and Class 3 7-year SBP trajectory.
表 3 显示，以 1 级基线 SBP 和 1 级 7 年 SBP 轨迹为参考，无论是单个因素还是多个因素，2 级基线 SBP 和 1 级 7 年 SBP 轨迹、2 级基线 SBP 和 2 级 7 年 SBP 轨迹、3 级基线 SBP 和 2 级 7 年 SBP 轨迹、3 级基线 SBP 和 3 级 7 年 SBP 轨迹的死亡风险均降低。

Combined all-cause mortality risk of all variables
所有变量的综合全因死亡风险

The risk model of the relationship between baseline SBP, 7-year SBP trajectory, age, gender, marital status, education level, smoking, drinking, physical activity, 7-year WC, 7-year TC, 7-year FBG, 7-year BMI, and all-cause mortality showed that older adults, male, unmarried, smoking, those who never drink alcohol, had an increased FBG, and had a baseline SBP >160mmHg had a relatively higher mortality risk. Women, married, with a college degree or above, never smoking, occasionally drinking alcohol, daily exercise, lower BMI, Grade2 baseline SBP, Class 2 and Class 3 7-year SBP trajectory increase group had a relatively lower mortality risk (Fig. 4).
基线 SBP、7 年 SBP 轨迹、年龄、性别、婚姻状况、教育程度、吸烟、饮酒、体力活动、7 年 WC、7 年 TC、7 年 FBG、7 年 BMI 与全因死亡率关系的风险模型显示，老年人、 男性、 未婚 、 吸烟、 从不饮酒、FBG 升高、基线 SBP >160mmHg 者的死亡风险相对较高。 女性、已婚、大专以上学历、从不吸烟、偶尔饮酒、 每日运动 、BMI 较低 、 基线 SBP 2 级 、SBP 2 级和 3 级 7 年轨迹升高组的死亡风险相对较低（图 4）。

Sensitivity analyses
敏感性分析

Through the analysis of the relationship between classified or continuous types of SBP and all-cause mortality, as well as the correlation analysis of baseline SBP, 7-year SBP trajectory with all-cause, cardiovascular, cancer, and other diseases mortality under single factor or multiple factors conditions, the results were relatively robust, indicating the reliability of our study.
通过分析分类或连续类型 SBP 与全因死亡率的关系，以及基线 SBP、7 年 SBP 轨迹与单因素或多因素条件下全因、心血管、癌症等疾病死亡率的相关性分析，结果相对稳健，表明本研究的可靠性。

Discussion
讨论

Our analysis of the natural population cohort of over 390 thousand elderly people aged 65 and above in this study showed a non-linear correlation between baseline SBP, 7-year mean SBP, and all-cause mortality. The correlation analysis between baseline SBP, 7-year mean SBP, and all-cause mortality rate in the study showed that the risk of mortality relatively high when SBP was less than 100 mmHg and >160 mmHg. When the baseline SBP was between 100-139 mmHg and increased with age, the risk of all-cause mortality in the elderly was lower.
本研究中，我们对超过 39 万 65 岁及以上老年人的自然人群队列进行了分析，结果显示基线 SBP、7 年平均 SBP 和全因死亡率之间存在非线性相关性。研究中基线 SBP、7 年平均 SBP 与全因死亡率的相关性分析显示，SBP <100 mmHg和>160 mmHg 时死亡风险相对较高。当基线 SBP 在 100-139 mmHg 之间并随年龄增加时，老年人全因死亡的风险较低。

The target blood pressure value for elderly people has always been controversial^1,17,18. Some studies supported strict control of blood pressure in the elderly³, while others suggested that overly strict blood pressure control may be harmful to the health of the elderly¹⁹. The most reported cases were among frail elderly individuals who may require higher SBP, which may have a protective effect on all-cause mortality^19,20. A study in primary care population aged above 75 showed that blood pressure <130/80 was associated with higher mortality¹⁹. There were also studies showing that elderly individuals with relatively high SBP and reduced functional and cognitive status also have lower mortality rates²¹, but some studies have shown different perspectives^6,22. Therefore, some researchers stated that the elderly need to decide how to control blood pressure based on individual circumstances²³. For the literatures that provided recommendations on blood pressure values for the elderly, the conclusions vary, with corresponding recommendations for SBP <120 mmHg, 130-139 mmHg, or 140-159 mmHg^24,25. Our article analyzed the relationship between baseline SBP, 7-year mean SBP, 7-year SBP trajectory, and overall cause of death, and suggested that the range of SBP values in elderly people should be above 100 mmHg to below 160 mmHg.
老年人的目标血压值一直存在争议 ^1，17，18。一些研究支持严格控制老年人的血压 ³，而另一些研究则认为过度严格的血压控制可能对老年人的健康有害 ¹⁹。 报告最多的病例是体弱的老年人，他们可能需要较高的 SBP，这可能对全因死亡率有保护作用 ^19，20。 一项针对 75 岁以上初级保健人群的研究表明，血压 <130/80 与较高的死亡率相关 。还有研究表明，SBP 相对较高且功能和认知状态降低的老年人死亡率也较低 ²¹，但一些研究显示了不同的观点 ^6，22。因此，一些研究人员表示，老年人需要根据个人情况决定如何控制血压 。 对于提供老年人血压值建议的文献，结论各不相同，相应的建议为 SBP <120 mmHg、130 - 139 mmHg 或 140 - 159 mmHg 24，25。 我们的文章分析了基线 SBP、7 年平均 SBP、7 年 SBP 轨迹和总体死亡原因之间的关系，并建议老年人的 SBP 值范围应在 100 mmHg 以上至 160 mmHg 以下。

Single or short-term observations may lead to inaccurate data and fail to reflect long-term changes in individuals. Regarding the ability of SBP trajectory to predict mortality, there were reports that long-term changes in SBP were an independent predictor of mortality, and SBP has greater significance for elderly people compared to diastolic blood pressure²⁶. At present, there have been some reports on the relationship between SBP trajectory and disease outcomes^27,28. Most reports indicated that a decrease in blood pressure trajectory in the elderly were associated with a higher risk of all-cause mortality and cardiovascular disease mortality compared to stable trajectories at high normal levels^27,29, and stable SBP levels in the moderate range were associated with lower mortality rates in the elderly³⁰. Some elderly people experienced an accelerated decline in their SBP trajectory in the last two years of life without controlling their blood pressure²⁶. This study showed that, after adjusting for sex, age, mental status, educational level, tobacco smoking, alcohol drinking, physical activity, 7-year WC, 7-year TC, 7-year FBG, 7-year BMI, the 7-year SBP trajectory was at Class 2, that was, blood pressure gradually increased from the normal-high value with age, and all-cause mortality was the lowest; the 7-year SBP trajectory is at Class 1, that was, blood pressure gradually increased from the ideal value with age, and cardiovascular mortality was the lowest; the 7-year SBP trajectory was at Class 3, where blood pressure gradually increased from mild hypertension with age, had the lowest mortality rates from cancer and other diseases other than cardiovascular and cancer. The combined analysis of 7-year SBP trajectory and baseline SBP showed that older adults with a baseline SBP between 100-139mmHg (Grades 2 and Grade3) with an ideal blood pressure or normal-high value (Grade2 and Grade3) at 65 years of age and a progressively increasing SBP trajectory with age (Class 2 and Class 3) were at lower risk in older adults.
单次或短期观察可能导致数据不准确，无法反映个人的长期变化。关于 SBP 轨迹预测死亡率的能力，有报告称 SBP 的长期变化是死亡率的独立预测因素，与舒张压相比，SBP 对老年人的意义更大 ²⁶。目前，已有一些关于 SBP 轨迹与疾病结局之间关系的报告 ^27，28。 大多数报告表明，与处于正常高水平的稳定轨迹相比，老年人血压轨迹下降与全因死亡率和心血管疾病死亡率的风险较高相关 ^27，29，并且在中等范围内稳定的 SBP 水平与老年人死亡率较低相关 ³⁰。一些老年人在生命的最后两年经历了 SBP 轨迹的加速下降，而没有控制他们的血压 ²⁶。 本研究表明，在调整性别、年龄、精神状态、受教育程度、吸烟、饮酒、体力活动、7 年腰围、7 年总胆固醇、7 年空腹血糖、7 年体重指数等因素后，7 年收缩压轨迹为 2 级 ， 即血压随年龄增长从正常值逐渐升高，全因死亡率最低 ;7 年收缩压轨迹为 1 级 ， 即血压随年龄增长从理想值逐渐升高，心血管死亡率最低 ;7 年收缩压轨迹为 3 级 ，即血压随年龄增长从轻度高血压逐渐升高 ，癌症及其他疾病死亡率最低 。 7 年 SBP 轨迹和基线 SBP 的联合分析显示，基线 SBP 在 100- 139 mmHg 之间（2 级和 3 级），65 岁时血压理想或正常 - 高值（2 级和 3 级），SBP 轨迹随年龄逐渐增加（2 级和 3 级）的老年人风险较低 。

In addition, one of the reasons why the target blood pressure of elderly people need to be comprehensively considered was that the tolerance of various organs or functions throughout the body to blood pressure may vary. Some studies suggested that the heart may require higher blood pressure. However, in clinical practice, the relationship between cardiac surgery and blood pressure targets was also unclear^31,32. The relationship between cognitive function and blood pressure levels in elderly people has also been reported differently^33,34. This study also showed that all-cause mortality, cardiovascular mortality, cancer mortality, and mortality from diseases other than cardiovascular and cancer were also different for different baseline SBP combined with 7-year SBP trajectories.
此外，老人家的血压目标需要综合考虑的原因之一 ，是全身各器官或功能对血压的耐受力可能不同。一些研究表明，心脏可能需要更高的血压。然而，在临床实践中，心脏手术和血压目标之间的关系也不清楚 ^31，32。 老年人的认知功能和血压水平之间的关系也有不同的报道 33，34。 该研究还表明，不同基线 SBP 结合 7 年 SBP 轨迹的全因死亡率、心血管死亡率、癌症死亡率以及心血管和癌症以外疾病的死亡率也不同。

This study has several strengths. We conducted a large-scale cohort study in a natural population aged 65 years and above, followed them for 7 years, and recorded their SBP data annually, which allowed us to accurately observe the trajectory of SBP and study the relationship between the dynamic changes of SBP and the risk of death, which provides an important reference for the prevention and control of hypertension, especially in the relatively economically underdeveloped areas of western China. In addition, this study conducted annual physical examinations for the elderly in the entire city of Luzhou, China, aiming to avoid selection bias caused by sampling surveys.
这项研究有几个优点。我们在 65 岁及以上的自然人群中进行了一项大规模队列研究，随访 7 年，每年记录他们的 SBP 数据，使我们能够准确观察 SBP 的轨迹，研究 SBP 的动态变化与死亡风险的关系，为高血压的预防和控制提供重要参考，特别是在中国西部经济相对不发达的地区。此外，本研究对泸州市的老年人进行了年度体检，以避免抽样调查造成的选择偏差。

Several limitations should be considered when interpreting our findings. Firstly, there were many reports indicating that there may be other better indicators reflecting changes in blood pressure, such as dynamic blood pressure, nighttime blood pressure, mean arterial pressure, moderate blood pressure, etc., which may better explain the risk of all-cause and cardiovascular death than clinical blood pressure^35-38. Due to limitations in conditions, the measurement of blood pressure changes mentioned above has not been included in the measurement of this study. Secondly, although we divided the 7-year SBP trajectory into three categories, we did not differentiate the magnitude of SBP changes in more detail, which may affect our results and interpretation. Next, we will consider further exploring more detailed grouping and incorporating more mortality outcome variables. Thirdly, most of the covariates we included were measured at baseline and cannot reflect the impact of changes during follow-up. Fourthly, many elderly people were in a comorbid state, and has not yet classified their disease status. Future research needs to further classify and explain the physical condition of the elderly, in order to provide more in-depth guidance on the formulation of SBP target values for the elderly.
在解释我们的研究结果时，应考虑几个限制。首先，有很多报道指出可能还有其他更好的反映血压变化的指标，如动态血压、夜间血压、平均动脉压、中等血压等，这可能比临床血压更好地解释全因和心血管死亡的风险 ^35-38。 由于条件限制，上述血压变化的测量未纳入本研究的测量中。 其次，虽然我们将 7 年 SBP 轨迹分为三类，但我们没有更详细地区分 SBP 变化的幅度，这可能会影响我们的结果和解释。 接下来，我们将考虑进一步探索更详细的分组，并纳入更多的死亡率结局变量。第三，我们纳入的大多数协变量是在基线时测量的，不能反映随访期间变化的影响。 第四，许多老年人处于共病状态，尚未对其疾病状态进行分类。未来的研究需要进一步对老年人的身体状况进行分类和解释，以便为老年人 SBP 目标值的制定提供更深入的指导。

Conclusion
结论

In summary, the 7-year prospective cohort results suggested that older adults with SBP rising with age from normal to stage 1 hypertension (no more than 160 mmHg), or even higher, from age 65, may be associated with lower mortality.
总之，7 年前瞻性队列研究结果表明，SBP 随年龄从正常升高至 1 级高血压（不超过 160 mmHg），甚至更高，从 65 岁开始升高的老年人可能与较低的死亡率相关 。

Conflict of interest: All the authors declare no conflict of interest.
利益冲突： 所有作者均声明无利益冲突。

Acknowledgments: We are grateful to all the participators in the present study, and to all the investigators for their support and hard work during this cohort.
致谢 ：我们感谢参与本研究的所有专家 ，以及所有研究者在本研究期间的支持和辛勤工作 。

Funding: This research was funded by National Major Science and Technology Project, Research on Innovation and Application Demonstration of Chronic Disease Prevention and Treatment Technology Promotion Mechanism (2024ZD0523905); Sichuan Provincial Primary Health Care Development Center of North Sichuan Medical College, Relationship between Care Model and Cognitive Function of Elderly Groups from the Perspective of Active Aging (SWFZ24 -Z-12); National Science and Technology Major Project, Research and Application Demonstration of Promotion Mechanism of Major Chronic Disease Prevention and Treatment Technology (2024ZD0523900).
资助： 本研究得到国家重大科技项目《慢性病防治技术推广机制创新与应用示范研究》资助（2024 ZD 0523905）;川北医学院四川省初级卫生保健发展中心，积极老龄化视角下的护理模式与老年群体认知功能的关系（SWFZ 24-Z-12）;国家科技重大专项重大慢性病防治技术推进机制研究及应用示范（2024 ZD 0523900）。

Author contributions: WZ and YP conceived the study. WZ, YH and WT analyzed the data and wrote the first draft. WZ, YP and ZZ interpreted the data and critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. WT and YP supervised the study, had full access to all data and had the final responsibility in deciding to submit for publication.
作者贡献：WZ 和 YP 构思了这项研究。WZ，YH 和 WT 分析了数据并撰写了初稿。WZ，YP 和 ZZ 解释了数据，并批判性地修改了手稿的知识内容。所有作者均阅读并批准了最终手稿。WT 和 YP 监督了这项研究，可以完全访问所有数据，并对决定提交出版负有最终责任。

Ethical Standards: The study was approved by the Ethics Committee of Luzhou
伦理标准： 泸州市伦理委员会批准

Center for Chronic Disease Control (LZCDC/LS-2023001).
慢性病控制中心 （LZCDC/LS-2023001）。

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Table 1 Baseline characteristics of participants according to SBP.
表 1 根据 SBP 的参与者的基线特征。

Abbreviations: SBP=systolic blood pressure; SD=standard deviation; WC=waist circumference; FBG=fasting blood glucose; TC=total cholesterol; BMI=body mass index.
缩略语：SBP=收缩压; SD=标准差; WC=腰围;FBG=空腹血糖 ;TC=总胆固醇;BMI=B 体质量指数 。
Grade1= <100 mmHg ; Grade2= 100~119 mmHg ; Grade3= 120~139 mmHg ; Grade4= 140~159 mmHg ; Grade5= 160~179 mmHg ; Grade6= ≥180 mmHg.
1 级 = <100mmHg ; 2 级 = 100~119mmHg ; 3 级 = 120~139mmHg ; 4 级 = 140~159mmHg ; 5 级 = 160~179mmHg ; 6 级 = ≥180 mmHg。

Class 1= Blood pressure gradually increases from ideal values with age; Class 2= Blood pressure gradually increases from normal-high values with age; Class 3= Blood pressure gradually increases from mild hypertension with age
1 类= 血压随年龄从理想值逐渐升高 ; 2 类= 血压随年龄从正常-高值逐渐升高 ; 3 类= 血压随年龄从轻度高血压逐渐升高.

Table 2 Association of baseline SBP and 7-year SBP trajectories with mortality.
表 2 基线 SBP 和 7 年 SBP 轨迹与死亡率的相关性。

Group 组	Number of deaths 死亡人数	Follow-up duration (person-years) 随访持续时间（人-年）	Mortality rate 死亡率 (per 10,000 person-years) (per 10，000 人年）	Adjusted HR (95% CI) 校正 HR（95% CI）
								Model 1a 型号 1a	Model 2b 型号 2b	Model 3c	Model 4d Model4D
Baseline SBP (mmHg) 基线 SBP（mmHg）
Grade1 1 级	762	32431.31	23.5	NA	NA	NA	NA
Grade2 2 级	6887	333512.47	20.65	0.87 ( 0.81 - 0.94 ) ** 0.87（0.81-0.94）**	0.86 ( 0.8 - 0.93 ) ** 0.86（0.8-0.93）**	0.9 ( 0.83 - 0.97 ) * 0.9（0.83-0.97）*	0.91 ( 0.84 - 0.98 ) * 0.91（0.84-0.98）*
Grade3 3 级	21710	947961.46	22.9	0.93 ( 0.87 - 1 ) 0.93（0.87-1）	0.86 ( 0.8 - 0.92 ) ** 0.86（0.8-0.92）**	0.91 ( 0.85 - 0.98 ) * 0.91（0.85-0.98）*	0.95 ( 0.89 - 1.03 ) 0.95（0.89-1.03）
Grade4 4 级	11277	437547.32	25.77	1.03 ( 0.96 - 1.11 ) 1.03（0.96-1.11）	0.9 ( 0.84 - 0.97 ) * 0.9（0.84-0.97）*	0.99 ( 0.92 - 1.07 ) 0.99（0.92-1.07）	1.07 ( 0.99 - 1.15 ) 1.07（0.99-1.15）
Grade5 5 级	5838	198981.74	29.34	1.16 ( 1.08 - 1.26 ) ** 1.16（1.08-1.26）**	0.99 ( 0.92 - 1.07 ) 0.99（0.92-1.07）	1.08 ( 1 - 1.17 ) * 1.08（1-1.17）*	1.17 ( 1.08 - 1.26 ) ** 1.17（1.08-1.26）**
Grade6 6 年级	1539	43616.12	35.29	1.41 ( 1.29 - 1.53 ) ** 重试    错误原因	1.18 ( 1.08 - 1.28 ) ** 重试    错误原因	1.28 ( 1.18 - 1.4 ) ** 重试    错误原因	1.38 ( 1.26 - 1.51 ) ** 重试    错误原因
7-year SBP trajectories 7 年 SBP 轨迹
Class 1 1类	18438	701689.26	26.28	NA	NA	NA	NA
Class 2 2类	22416	980183.86	22.87	0.85 ( 0.83 - 0.87 ) ** 重试    错误原因	0.92 ( 0.9 - 0.94 ) ** 重试    错误原因	0.96 ( 0.94 - 0.98 ) ** 0.96（0.94-0.98）**	0.9 ( 0.88 - 0.92 ) ** 0.9（0.88-0.92）**
Class 3 3类	7159	312177.3	22.93	0.86 ( 0.83 - 0.88 ) ** 0.86（0.83-0.88）**	1.03 ( 1 - 1.06 ) * 1.03（1-1.06）*	1.1 ( 1.06 - 1.13 ) ** 1.1（1.06-1.13）**	0.93 ( 0.9 - 0.96 ) ** 0.93（0.9-0.96）**

Abbreviations: SBP=blood pressure; HR=hazard ratio; CI=confidence interval.
缩略语：SBP=血压; HR=风险比; CI=置信区间。
Grade1= <100 mmHg ; Grade2= 100~119 mmHg ; Grade3= 120~139 mmHg ; Grade4= 140~159 mmHg ; Grade5= 160~179 mmHg ; Grade6= ≥180 mmHg.
1 级 = <100 mmHg ; 2 级 = 100~119 mmHg ; 3 级 = 120~139 mmHg ; 4 级 = 140~159 mmHg ; 5 级 = 160~179 mmHg ; 6 级 = ≥180 mmHg。
Class 1= Blood pressure gradually increases from ideal values with age; Class 2= Blood pressure gradually increases from normal-high values with age; Class 3= Blood pressure gradually increases from mild hypertension with age
1 类= 血压随年龄从理想值逐渐升高 ; 2 类= 血压随年龄从正常-高值逐渐升高 ; 3 类= 血压随年龄从轻度高血压逐渐升高.
^a Model 1 was univariate analysis.
^a 模型 1 为单变量分析。
^b Model 2 adjusted for sex, age.
^B 模型 2 调整了性别、年龄。
^c Model 3 included variables in model 1 and further adjusted for marital status, educational level, tobacco smoking, alcohol drinking, physical activity, 7-year average waist circumference, 7-year average fasting blood glucose, 7-year average total cholesterol , 7-year average body mass index
^c 模型 3 包括模型 1 中的变量，并进一步调整了婚姻状况、教育水平、吸烟、饮酒、体力活动、7 年平均腰围、7 年平均空腹血糖、7 年平均总胆固醇 、7 年平均 Body 质量指数 。.
^d Model 4 included variables in model 2 and further adjusted for SBP trajectories or SBP at baseline.
d 模型 4 包括模型 2 中的变量，并根据 SBP 轨迹或基线 SBP 进一步调整。
*: P<0.05; **: P<0.01.
* ：P<0.05; **：P<0.01。

Table 3 Association of different combinations of baseline SBP and 7-year SBP trajectories with mortality.
表 3 基线 SBP 和 7 年 SBP 轨迹的不同组合与死亡率的相关性。

Group 组 （Grade+Class） （ 年级+ 班级 ）	Number of deaths 死亡人数	Follow-up duration 随访时间 (person-years) （人-年）	Mortality rate 死亡率 (per 10,000 person-years) (per 10，000 人年）	Adjusted HR (95% CI) 校正 HR（95% CI）
								Model 1a 型号 1a	Model 2b 型号 2b	Model 3c
1 + 1	702	29399.91	23.88	NA	NA	NA
1 + 2	57	2881.76	19.78	0.77 ( 0.59 - 1.01 )	0.82 ( 0.63 - 1.07 )	0.8 ( 0.61 - 1.05 )
1 + 3	3	149.64	20.05	0.84 ( 0.27 - 2.61 )	0.83 ( 0.27 - 2.57 )	0.84 ( 0.27 - 2.61 )
2 + 1	5599	255090.73	21.95	0.91 ( 0.84 - 0.98 ) * 0.91（0.84-0.98）*	0.88 ( 0.82 - 0.95 ) * 0.88（0.82-0.95）*	0.91 ( 0.84 - 0.98 ) * 0.91（0.84-0.98）*
2 + 2	1233	74638.36	16.52	0.67 ( 0.61 - 0.74 ) ** 0.67（0.61-0.74）**	0.73 ( 0.66 - 0.8 ) ** 0.73（0.66-0.8）**	0.77 ( 0.71 - 0.85 ) ** 0.77（0.71-0.85）**
2 + 3	55	3783.38	14.54	0.57 ( 0.44 - 0.76 ) ** 0.57（0.44-0.76）**	0.72 ( 0.55 - 0.94 ) * 0.72（0.55-0.94）*	0.77 ( 0.58 - 1.01 )
3 + 1	10470	373887.36	28	1.12 ( 1.04 - 1.21 ) * 1.12（1.04-1.21）*	0.92 ( 0.86 - 1 ) * 0.92（0.86-1）*	0.96 ( 0.88 - 1.03 )
3 + 2	10276	514724.5	19.96	0.79 ( 0.73 - 0.86 ) ** 0.79（0.73-0.86）**	0.79 ( 0.73 - 0.85 ) ** 0.79（0.73-0.85）**	0.85 ( 0.79 - 0.92 ) ** 0.85（0.79-0.92）**
3 + 3	964	59349.6	16.24	0.64 ( 0.58 - 0.71 ) ** 0.64（0.58-0.71）**	0.73 ( 0.66 - 0.81 ) ** 0.73（0.66-0.81）**	0.79 ( 0.72 - 0.87 ) ** 0.79（0.72-0.87）**
4 + 1	1515	39514.3	38.34	1.45 ( 1.33 - 1.59 ) ** 1.45（1.33-1.59）**	0.93 ( 0.85 - 1.02 )	0.99 ( 0.9 - 1.08 )
4 + 2	7589	290091.26	26.16	1.02 ( 0.95 - 1.11 )	0.89 ( 0.82 - 0.96 ) * 0.89（0.82-0.96）*	0.97 ( 0.9 - 1.05 )
4 + 3	2173	107941.76	20.13	0.8 ( 0.74 - 0.87 ) ** 0.8（0.74-0.87）**	0.86 ( 0.79 - 0.94 ) ** 0.86（0.79-0.94）**	0.96 ( 0.88 - 1.05 )
5 + 1	140	3628.75	38.58	1.47 ( 1.23 - 1.77 ) ** 1.47（1.23-1.77）**	0.78 ( 0.65 - 0.94 ) * 0.78（0.65-0.94）*	0.71 ( 0.59 - 0.85 ) ** 0.71（0.59-0.85）**
5 + 2	2928	88804.62	32.97	1.26 ( 1.16 - 1.37 ) ** 1.26（1.16-1.37）**	0.95 ( 0.88 - 1.04 )	1.04 ( 0.96 - 1.13 )
5 + 3	2770	106548.37	26	1.02 ( 0.94 - 1.11 )	1.01 ( 0.93 - 1.09 )	1.1 ( 1.01 - 1.2 ) * 1.1（1.01-1.2）*
6 + 1	12	168.21	71.34	2.55 ( 1.44 - 4.52 ) * 2.55（1.44-4.52）*	1.16 ( 0.65 - 2.05 )	1.37 ( 0.77 - 2.43 )

Abbreviations: SBP=blood pressure; HR=hazard ratio; CI=confidence interval.
缩略语：SBP=血压; HR=风险比; CI=置信区间。
Grade1= <100 mmHg ; Grade2= 100~119 mmHg ; Grade3= 120~139 mmHg ; Grade4= 140~159 mmHg ; Grade5= 160~179 mmHg ; Grade6= ≥180 mmHg.
1 级 = <100mmHg ; 2 级 = 100~119mmHg ; 3 级 = 120~139mmHg ; 4 级 = 140~159mmHg ; 5 级 = 160~179mmHg ; 6 级 = ≥180 mmHg。
Class 1= Blood pressure gradually increases from ideal values with age; Class 2= Blood pressure gradually increases from normal-high values with age; Class 3= Blood pressure gradually increases from mild hypertension with age
1 类= 血压随年龄从理想值逐渐升高 ; 2 类= 血压随年龄从正常-高值逐渐升高 ; 3 类= 血压随年龄从轻度高血压逐渐升高.
^a Model 1 was univariate analysis. ^b Model 2 adjusted for sex, age. ^c Model 3 included variables in model 1 and further adjusted for marital status, educational level, tobacco smoking, alcohol drinking, physical activity, 7-year average waist circumference, 7-year average fasting blood glucose, 7-year average total cholesterol , 7-year average body mass index
^a 模型 1 为单变量分析。^B 模型 2 调整了性别、年龄。^c 模型 3 包括模型 1 中的变量，并进一步调整了婚姻状况、教育水平、吸烟、饮酒、体育活动、7 年平均腰围、7 年平均空腹血糖、7 年平均总胆固醇、7 年平均 Body 质量指数 。.
*: P<0.05; **: P<0.01
* ：P<0.05; **：P<0.01.

Figure Legends
图例

Fig. 1. The study participants inclusion and exclusion process.
Fig. 1. 研究参与者的入选和排除过程。

Fig. 2. Association of baseline SBP and 7-year mean SBP as a continuous scale with mortality.
图二 . 基线 SBP 和 7 年平均 SBP 作为连续量表与死亡率的相关性 。

Note: HRs (solid line) and 95% CIs (shadow) from Cox proportional hazards regression models using restricted cubic splines.
注 ：HR（实线）和 95% CI（阴影）来自使用限制性三次样条的考克斯比例风险回归模型。

Graphs were truncated at 80 and 200 mmHg for more than 96% of participants were located between these cut points.
在 80 和 200 mmHg 下截断图形，超过 96% 的参与者位于这些切割点之间。

Abbreviations: SBP=systolic blood pressure; CI= confidence interval.
缩略语：SBP=收缩压;CI=置信区间。

Fig. 3. Association of baseline and 7-year mean SBP as continuous variables with mortality in elderly aged 65-79, 70-74, 75-79, and over 80 years old.
图三 . 基线和 7 年平均 SBP 作为连续变量与 65-79 岁、70-74 岁、75-79 岁和 80 岁以上老年人死亡率的相关性

Note: HRs (solid line) and 95% CIs (shadow) from Cox proportional hazards regression models using restricted cubic splines.
注 ：HR（实线）和 95% CI（阴影）来自使用限制性三次样条的考克斯比例风险回归模型。

Graphs were truncated at 80 and 200mmHg for more than 96% of participants were located between these cut points.
在 80 和 200 mmHg 下截断图，超过 96% 的参与者位于这些分界点之间。

Abbreviations: SBP=systolic blood pressure; CI= confidence interval.
缩略语：SBP=收缩压;CI=置信区间。

Fig. 4. Hazard ratio for the combined associations of age, gender, marital status, educational level, tobacco smoking, alcohol drinking, physical activity, 7-year average WC, 7-year average FBG, 7-year average TC, 7-year average BMI, baseline SBP grade and 7-year SBP trajectories with all-cause mortality
见图 4。年龄、性别、婚姻状况、教育水平、吸烟、饮酒、体力活动、7 年平均 WC、7 年平均 FBG、7 年平均 TC、7 年平均 BMI、基线 SBP 等级和 7 年 SBP 轨迹与全因死亡率的联合相关性的风险比.

Note: Class 1= Blood pressure gradually increases from ideal values with age; Class 2= Blood pressure gradually increases from normal-high values with age; Class 3= Blood pressure gradually increases from mild hypertension with age
注意事项：1类=血压随年龄从理想值逐渐升高; 2类=血压随年龄从正常-高值逐渐升高; 3类=血压随年龄从轻度高血压逐渐升高.

Grade1= <100 mmHg ; Grade2= 100~119 mmHg ; Grade3= 120~139 mmHg ; Grade4= 140~159 mmHg ; Grade5= 160~179 mmHg ; Grade6= ≥180 mmHg.
1 级 = <100mmHg ; 2 级 = 100~119mmHg ; 3 级 = 120~139mmHg ; 4 级 = 140~159mmHg ; 5 级 = 160~179mmHg ; 6 级 = ≥180 mmHg。

Abbreviations: SBP=systolic blood pressure; WC=waist circumference; FBG=fasting blood glucose; TC=total cholesterol; BMI=body mass index; HR=hazard ratio.
缩略语：SBP=收缩压; WC=腰围; FBG=空腹血糖 ;TC=总胆固醇;BMI=B 体质量指数 ; HR=风险比。

Fig. S1. The trajectory of systolic blood pressure in the elderly for 7 years, Luzhou, China, 2017-2023.
图 S1. 2017-2023 年中国泸州市老年人 7 年收缩压变化轨迹

Note: Class 1= Blood pressure gradually increases from ideal values with age;
注 ：1 级= 血压随着年龄的增长从理想值逐渐升高 ;

Class 2= Blood pressure gradually increases from normal-high values with age;
2 级= 血压随着年龄的增长从正常值逐渐升高至高值;

Class 3= Blood pressure gradually increases from mild hypertension with age
3级=血压随着年龄的增长从轻度高血压逐渐升高.

Abbreviations: SBP=systolic blood pressure.
缩略语：SBP=收缩压。

Fig. S2. Kaplan-Meier overall survival estimates, comparison of mortality in participants stratified by SBP trajectories and
图 S2. Kaplan-Meier 总生存期估计值 ， 按 SBP 轨迹分层的受试者死亡率比较 ，.

Note: Grade1= <100mmHg ; Grade2= 100~119mmHg ; Grade3= 120~139mmHg ; Grade4= 140~159mmHg ; Grade5= 160~179mmHg ; Grade6= ≥180mmHg.
注 ：1 级 = <100mmHg ; 2 级 = 100~119mmHg ; 3 级 = 120~139mmHg ; 4 级 = 140~159mmHg ; 5 级 = 160~179mmHg ; 6 级 = ≥ 180 mmHg。

Class 1= Blood pressure gradually increases from ideal values with age;
1 级= 血压随着年龄的增长从理想值逐渐升高 ;

Class 2= Blood pressure gradually increases from normal-high values with age;
2 级= 血压随着年龄的增长从正常值逐渐升高至高值;

Class 3= Blood pressure gradually increases from mild hypertension with age
3级=血压随着年龄的增长从轻度高血压逐渐升高.

Abbreviations: SBP=systolic blood pressure.
缩略语：SBP=收缩压 。

Fig. S3. Association of adjusted baseline SBP and 7-year mean SBP as a continuous scale with mortality.
图 S3. 校正的基线 SBP 和 7 年平均 SBP 作为连续量表与死亡率的相关性 。

Note: HRs (solid line) and 95% CIs (shadow) from Cox proportional hazards regression models using restricted cubic splines. Covariates included marital status, educational level, tobacco smoking, alcohol drinking, physical activity, 7-year average waist circumference, 7-year average fasting blood glucose, 7-year average total cholesterol , 7-year average body mass index.
注 ： 使用限制三次样条的考克斯比例风险回归模型的 HR（实线）和 95%CI（阴影）。协变量包括婚姻状况、文化程度、吸烟、饮酒、体力活动、7 年平均腰围、7 年平均空腹血糖、7 年平均总胆固醇、7 年平均 B 体质量指数 。

Graphs were truncated at 80 and 200mmHg for more than 96% of participants were located between these cut points.
在 80 和 200mmHg 下截断图 ，超过 96% 的参与者位于这些分界点之间。

Abbreviations: SBP=systolic blood pressure; CI= confidence interval.
缩略语：SBP=收缩压;CI=置信区间。